"Regardless of my objections to the Affordable Care Act, the Department of Health and Human Services needs competent leadership," said Sen. John McCain, R-Ariz. "I believe Ms. Burwell has the qualifications to run Health and Human Services."

Sen. Richard Burr, R-N.C., said he intended to vote for Burwell because she had "a portfolio of experience that would make her a tremendous asset" to the Department of Health and Human Services.

Burwell, 48, has been Obama's budget director for the past year. Sen. John Barrasso of Wyoming, a point man for Republicans on health care, said he voted for her to be director of the Office of Management and Budget in April 2013. Without making a commitment to vote for her this time, Barrasso said, "She's a capable individual."

The nominee clearly benefited from the contrast with Sebelius, whose relations with Republican lawmakers ranged typically from strained to nonexistent.

McCain said Burwell had assured him that "she will work with members of Congress, as she has as director of OMB, and be more responsive to its members than her predecessor."

The hearing was held by the Senate Committee on Health, Education, Labor and Pensions, headed by Sen. Tom Harkin, D-Iowa. The Senate Finance Committee plans a separate confirmation hearing, perhaps as early as next week.

Senators did not test Burwell's knowledge of Medicare or Medicaid and allowed her to skitter away from difficult questions, like the role of the Office of Management and Budget in supervising information technology for HealthCare.gov, the online federal insurance marketplace serving three dozen states.

The website stymied millions of people who tried to sign up for insurance in October and November.

Burwell went beyond prior administration policy on at least one issue on Thursday, saying she supported an extension of the Children's Health Insurance Program.